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As coronavirus cases continue to climb in more than 20 states, raising fears of a second wave of hospitalizations and deaths, some politicians have taken to waving away the worrisome news with a rudimentary, reassuring explanation.
Of course the number of COVID-19 cases is going up, they say. That’s what happens when you test more people: You find more infections.
On Monday, President Trump added his voice to this soothing chorus. “Our testing is so much bigger and more advanced than any other country (we have done a great job on this!) that it shows more cases,” Trump tweeted in the morning. “Without testing, or weak testing, we would be showing almost no cases. Testing is a double edged sword - Makes us look bad, but good to have!!!”
“If we stop testing right now,” the president added during an event for seniors at the White House, “we’d have very few cases, if any.”
And according to a report in the New York Times, Vice President Mike Pence echoed Trump’s argument during a call Monday with governors, urging them “to continue to explain to your citizens the magnitude of the increase in testing” in order to “encourage people with the news that we’re safely reopening the country.”
Trump is right about one thing: The U.S. is now conducting more COVID-19 tests than any other country, in total (about 465,000 a day) and per capita (about 1.25 per 1,000 residents). But his nonsensical, if-a-tree-falls-in-the-forest suggestion that somehow coronavirus infections would cease to exist if we stopped trying to detect them is dangerously deluded, and saying so only contributes to a sense of complacency that threatens to further accelerate the spread of the virus.
It doesn’t take advanced math to debunk Trump’s claim. Just look at Florida, where Republican Gov. Ron DeSantis, one of the president’s staunchest allies, has recently been brushing off questions from reporters with a similar line.
“As you’re testing more, you’re going to find more cases,” DeSantis said Thursday.
Florida has certainly been finding more cases. On Monday, the Sunshine State reported a daily increase of 1,758 COVID-19 infections. That number follows two days with more than 2,000 new coronavirus cases, including the state’s highest-ever daily total on Saturday (2,581). It also represents the 12th day out of the last 13 that the state has announced more than 1,000 new cases.
This means Florida’s seven-day rolling average of COVID-19 infections — an important metric that helps to balance out daily fluctuations in reporting — has gone up every day since the beginning of the month. On June 1, Florida’s seven-day average stood at 726 cases per day. As of June 15, it had more than doubled to 1,775.
If Trump and DeSantis were right that testing accounts for this increase, it should also show up as a proportional increase in the number of new tests conducted each day over the same period.
But that’s not what the data shows. In reality, Florida has been conducting roughly the same average number of COVID-19 tests every day for the last month. During the last two weeks of May, the state conducted 369,557 tests in total, or 26,396 per day on average. During the first two weeks of June, the state conducted 387,666 tests in total, or 27,690 per day on average.
In other words, the number of tests conducted per day in Florida was unchanged, while average cases more than doubled. And so Trump and DeSantis are incorrect: Testing doesn’t explain Florida’s recent increase in infections.
The truth about testing is that it delivers diminishing returns. Sure, there’s an initial relationship between increased testing and increased case counts; the people who seek out tests first are the most likely to be sick. But scale up capacity and you start to test more and more people with less and less chance of infection. Eventually, there’s not much correlation between the amount of testing and the scale of an epidemic.
Other data from Florida reflects this dynamic as well. For instance: If the size of the state’s outbreak were stable — and if the growing case count were simply the inevitable, even desirable byproduct of increased testing — then the percentage of positive tests per day would be going down (or, at worst, staying the same).
Instead, Florida’s seven-day rolling average of positive tests rose from 3.85 percent on June 1 to 6.35 percent on June 15.
Likewise, if Florida were merely detecting more cases through increased testing — without more people there actually getting sick — then the number of residents showing up at hospitals with COVID-19 would be holding steady.
It’s not, though. Over the last week, the state’s seven-day average of new hospitalizations has climbed from a little more than 100 per day to nearly 150 per day.
Florida is hardly alone in this. Between June 7 and June 14, the seven-day rolling average of positive tests rose from 6.2 percent to 13.5 percent in Alabama, from 12.3 percent to 15.6 percent in Arizona, from 5.6 percent to 19.7 percent in Mississippi and from 6.4 percent to 13.7 percent in South Carolina — a sign that their outbreaks are growing, regardless of testing capacity. Many other states, including Alaska, Nevada, Idaho, Oklahoma, Oregon, South Dakota, Texas and Wyoming, have also registered rising positive-testing rates in recent days.
There are some places where increased testing is, in fact, detecting more asymptomatic infections, such as California. There, the seven-day average of total daily tests has risen from about 53,000 to 63,000 so far this month — even as hospitalizations have leveled off and the positive-test rate has fallen from about 5 percent to about 4.5 percent.
But that is not the story in Florida, or in many of the other states where case counts are soaring. Rt is an epidemiological statistic that represents transmissibility, or the number of people a sick person infects at a particular point in an epidemic. An Rt below 1.0 indicates that each person infects, on average, less than one other person; an Rt above 1.0 indicates that an outbreak is growing. Six weeks ago, only 10 states had an Rt of 1.0 or higher. Today, 18 states are hovering above that troubling threshold.
For now, none of these states looks like the next New York City. The percentage of residents infected with COVID-19 remains relatively low. Testing capacity is much higher than before. Hospitals aren’t stretched thin yet. People understand how to wear masks and keep their distance, even if they’re tired of it. New outbreaks shouldn’t catch Americans by surprise.
The operative word, however, is shouldn’t. If we refuse to accept why those outbreaks are happening, we may also refuse to do what it takes to stop them from spiraling out of control. Telling ourselves that it’s all just a result of more testing absolves us of responsibility. Things only look bad because we’re doing something good, Trump says. Our behavior isn’t to blame.
But our behavior is to blame. The coronavirus doesn’t magically retreat when a governor decides it’s time to relax lockdown measures. The pathogen will continue to spread wherever and whenever people interact at a distance of less than 6 feet, without a mask and especially indoors.
As states reopen — and many of the states with rising case counts were among the earliest and most eager to resume business as usual — the more their residents start to ease up on social distancing. The more people ease up, the more they risk contracting the coronavirus.
Some of this risk is tolerable — the unavoidable cost of coexisting with a virus to which we have not yet developed any immunity. But if we insist, like Trump, that there is no cost to letting down our guard — that the virus isn’t spreading; that rising case counts are a statistical illusion; that there is no reason for caution — then we may not recognize and respond to what’s really happening until it’s too late.
America tried that once before. It didn’t go well.
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